
Laguna Honda: Finish the Job—Open the Doors.
Health Commission Must Take Action!

• • • • • • • • January 2025 • • • • • • • •
Why are ALL types of admissions so slow? As of the end of November, less than 430 of the 769 licensed nursing home beds at LHH were occupied. Even if you subtract the 120 beds that need a special waiver, we have over 200 empty beds.
San Franciscans are waiting for a fully functioning long-term care facility to resume its mission.
1. There is a lack of transparency about the admissions process. There are multiple empty beds (over 300) with very slow admission rates. Is Laguna Honda/SFDPH really reaching out to those in need in the community? I haven't seen anything in emails from the Mayor or Board of Supervisors. I have not heard about presentations at Senior Centers. There has been no public outreach or encouragement for San Franciscans who need a nursing home for safety and quality of life. Is the admission process welcoming to overwhelmed caregivers?
2. Focus on short-term, post-acute rehab will not fill the beds or meet the needs of many San Franciscans: In order to generate more revenue, there has been a focus by the SF Health Dept. and the Health Commission on short-term post-acute "rehab" stays (generates the most dollars, especially for patients insured by Medicare and/or private insurance). "Post acute rehab" pays less for patients on Medi-Cal (Medicaid) without Medicare, but still fetches a higher daily rate than long-term or "custodial care."

Despite repeated requests from both the public and Health Commissioners, a detailed monthly report on admissions, discharges, and deaths has yet to be provided.”
At Laguna Honda Hospital (LHH) post-acute rehab is surely needed. However, our public facility should serve the nursing home needs of all San Franciscans and not just those with short-term post-acute rehab needs. The "market" for "post acute rehab" for folks with Medicare and/or private insurance is competitive. In fact, almost all nursing homes try to maximize admissions of this category of patients and then try to (often illegally) get rid of (discharge) "post-acute" patients after they no longer qualify for "rehab," even if they still need to live in a nursing home.
3. San Franciscans are aging and need long-term beds: Long-term or "custodial" stays at a nursing home are paid for (at lower rates than "rehab") only by Medi-cal (Medicaid), only partially by expensive long-term care insurance which few can afford, or cash. Medicare and other health insurance do not pay for long-term care. Yet, in a city with an aging population, the need for long-term nursing home care is increasing. Multiple nursing home beds have closed in the past 20 years. San Franciscans who need nursing home care and don't get it are at risk of suffering and dying at home or in residential facilities (which are non- medical). The results of inadequate skilled nursing care, such as infected bed sores, other treatable infections, or malnutrition/dehydration are predictable. The natural history of these unfortunate people is to go in and out of the hospital and die due to a lack of 24-hour skilled care. And it is quite devastating for a San Franciscan who is dependent on nursing home care to have to move out of the county, away from family and friends.
One answer, of course, is to improve home care, but this will not serve everybody. Folks with brain injury or progressive cognitive problems (such as dementia) or who are medically complex (or both) often cannot be stabilized outside of a nursing home.
4. Has a decision been made to "lose" 120 nursing home beds? CMS (the federal government) will not allow Laguna Honda to fill 120 licensed nursing home beds because of a 2016 regulation that says all nursing homes opened after 2016 have to have no more than a two-bed-to-bathroom ratio. Although Laguna Honda has been continuously open (despite being decertified in April 2022), CMS is using the decertification to treat LHH like a new nursing home. The LHH building was finished in 2010. The 120 three-bed suites are spacious, airy, and private, although they do share a bathroom. SFDPH leaders have stated in the past that CMS is likely to grant an application for a "waiver" to this regulation only when LHH "proves" that improvement is "sustained." Only then can those 120 beds be filled. At this time, several state and federal surveyors have come and gone. LHH has been fully certified for months. SFDPH/LHH leaders have stopped mentioning these 120 beds, and there is no recent talk of submitting a waiver. This is disturbing. San Franciscans need these beds.
5. Why are ALL types of admissions so slow? On November 12, LHH reported it had admitted 28 patients between July 31 and October 31, after LHH was allowed to resume admissions at the end of June. That was a net gain of just six patients, after deaths and discharges. As of November 22, LHH only had 425 patients in its 769 licensed nursing home beds, which represented occupancy of just 56% of LHH’s capacity. Admitting patients to the 344 unfilled remaining beds would go a long way towards reducing the number of San Franciscans discharged to out-of-county nursing homes for needed care.
6. Management and Leadership at Laguna Honda: will ongoing problems jeopardize the very existence of this skilled nursing facility? The people of San Francisco need to clearly see that the future of Laguna Honda will be different than the recent past. There has been, is and will be a lack of upper management in SFHN (San Francisco Health Network, run by SFDPH) who are trained in Nursing Home Administration and regulations. There has been, is and will be ongoing political and economic pressure to use Laguna Honda to balance the budget for other city entities (such as hard-to-discharge patients at San Francisco General Hospital)—or to misuse it in a penny-wise, pound-foolish fashion. It is important that medical and nursing leaders at Laguna Honda be respected and not simply subservient to the SFHN/SFDPH line of command. It is important that both the Laguna Honda Nursing Home Administrator and Assistant Nursing Home Administrator are certified as such. This is currently not the case, as it was not the case for many years leading up to the 2022 decertification mess.
Upcoming Health Commission Meetings:
Tuesday | Jan 7th, 2025 | 4 pm Agenda will come out the Friday pm prior (Friday, Jan 3rd): this is a general health commission meeting and may have limited information about LHH. Agenda will be posted.
Monday |Jan 13th, 2025 | 4 pm Second SFDPH budget hearing. This meeting will also include open and closed-session items usually contained on the Laguna Honda Hospital Joint Conference Committee meeting agenda. More details about the meeting agenda will be posted on Friday January 10, 2025.
Example of a letter to the Health Commission for the Dec. 17 Budget meeting and Laguna Honda Update: note that testimony must be 150 words or less for agenda item if you want to get published in the minutes:
LETTER
To: Mark Morewitz, Secretary of the Health Commission. <mark.morewitz@sfdph.org>
Dec 17 2024
Dear Mr. Morewitz,
Please distribute this public comment to the Commissioners and include in the written minutes. I am commenting on agenda items 3, 6, 7 related to Laguna Honda Hospital and all three are below. I hope this format is OK and does not inconvenience you. Thank you, Ann C.
3) GENERAL PUBLIC COMMENT
Laguna Honda and the Missing 120 Beds
The public continues to await a clear commitment to restore the 120 beds that CMS vacated due to a technicality. San Francisco cannot afford to permanently lose these vital nursing home beds. Additionally, we request a transparent summary of recent visits to Laguna Honda by regulatory agencies.
Respectfully submitted,
Ann Colichidas, Gerontologist, LTCA
Gray Panther of San Francisco
(54 words)
6) FOR DISCUSSION: LHH ADMISSIONS UPDATE
Admissions continue to progress at a painfully slow pace, with only a slight increase in the total census over time. Is this lack of admissions due to insufficient outreach and education by SFDPH for those in need of nursing home care, or could it be the result of the overly burdensome application process? Despite repeated requests from both the public and Health Commissioners, a detailed monthly report on admissions, discharges, and deaths has yet to be provided.
Respectfully submitted,
Ann Colichidas, Gerontologist, LTCA
Gray Panther of San Francisco
(77 words)
7) FOR ACTION: AMENDMENTS TO THE LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER (LHH) GOVERNING BODY BYLAWS
Dear Commissioners,
Thank you for pausing during the December 3 meeting to carefully reconsider the proposed Bylaw changes in response to the significant public concern they generated. It's clear that you were under considerable pressure, especially with the impending survey that could occur at any moment. Mr. Morewitz's presentation and accompanying documents provided valuable context. However, the removal of all references to long-term care remained deeply concerning, and his comment regarding public distrust resonated with me. I believe this distrust is not directed at the Commission itself, but rather at the priorities and goals of the Breed administration regarding Laguna Honda and other matters of significant public interest. I appreciate your thoughtful oversight and look forward to today's discussion.
Respectfully submitted,
Ann Colichidas, Gerontologist, LTCA
Gray Panther of San Francisco
(120 words)
Dr. Teresa Palmer M.D., Family Medicine/Geriatrics. Laguna Honda 1989-2004
January 2025